Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA.
Department of Psychology, Texas State University, San Marcos, 78666, TX, USA.
BMC Med Educ. 2024 Apr 15;24(1):413. doi: 10.1186/s12909-024-05371-9.
Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes.
This study investigated the impact of virtual human interaction (VHI) training on clinicians' self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians' verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians' empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians' negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions.
Clinician participants' negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group.
Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.
与有自杀风险的患者合作的临床医生通常会经历高度压力，这可能导致负面情绪反应（NER）。这种负面情绪反应可能导致同理心沟通（EC）减少和对患者的无意拒绝，从而可能破坏治疗联盟并对自杀结果产生不利影响。因此，临床医生需要接受培训，以有效管理对自杀患者的负面情绪，从而改善自杀结果。
本研究通过治疗师反应问卷自杀形式评估了虚拟人交互（VHI）培训对临床医生对其自杀患者负面情绪反应的自我意识的影响，通过同理心沟通和编码系统评估了临床医生的口头同理心沟通，以及临床疗效（CE）。临床疗效通过后续预约的可能性、个体感知的帮助程度和总体交互满意度来评估，这些个体具有自杀尝试的生活经验。使用了两种虚拟人交互条件：一种带有口头同理心沟通的说明，并在交互过程中提醒报告负面情绪反应（有支架）；另一种没有这样的说明或提醒（无支架）。两种条件都提供了预交互说明和后交互反馈，旨在改善临床医生的同理心沟通和管理负面情绪的能力。62 名临床医生在两种条件之一下参加了三个虚拟人交互会话。线性混合模型用于评估对临床医生的负面情绪反应、口头同理心沟通和临床疗效的影响；并确定这些结果随时间的变化，同时由培训条件进行调节。
在两种条件下，经过两次虚拟人交互培训后，临床医生的负面情绪反应均有所下降。在一个培训会话中，有支架条件下的参与者表现出同理心沟通增强，而无支架条件下的参与者则需要两个培训会话。令人惊讶的是，经过两次培训会话，无支架组的临床疗效得到了改善，而有支架组则没有类似的改善。
在具有较高口头同理心沟通能力的临床医生中，虚拟人交互培训后的临床疗效较低表明，与自杀患者互动时，非言语表达的同理心至关重要。未来的工作应探索虚拟人交互培训在非言语和口头同理心沟通方面的应用。
